Directs the Government Accountability Office to evaluate and report on the inpatient and outpatient treatment capacity, availability, and needs of the United States in regard to opioid use disorder.

Updated lastApril 27, 2017

for the 02/09/2017 version of HR 994.

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What it does

HR 994 establishes the framework to assess the capacity and availability of America’s opioid treatment infrastructure, as well as to identify areas of needed infrastructure in addressing the escalating opioid epidemic.

An assessment of the barriers at the federal, state, and local levels to real-time reporting of de-identified drug overdose statistics, as well as suggestions to overcome those barriers.

Relevant Science

Opioids are a class of drugs that bind to opioid receptors in the brain, producing pain-relieving and euphoric effects. Opioids are either derived naturally from the opium poppy plant (e.g., morphine and codeine, commonly referred to as opiates), partially synthesized from opium (e.g., heroin, oxycodone, and hydromorphone), or fully synthesized to mimic the effects of opium (e.g., fentanyl and methadone.) Medically, these drugs are primarily used for their analgesic (i.e., pain-relieving) properties, but are often misused, overprescribed, and abused given their propensity for dependence.

Rates of opioid dependence have significantly increased in the United States over the past two decades, resulting in a drastic increase in overdose deaths nationwide. Prescription medications, such as oxycodone (commonly marketed as OxyContin), are viewed as a primary catalyst in the spike of opioid use. After prescriptions run out, patients may turn to illicit opiates, such as heroin. In 2013, the Substance Abuse and Mental Health Services Administration estimated that over 1.8 million people suffer from opioid use disorder. The Center for Disease Control estimates that over 33 thousand people died from opioid overdoses in 2015 alone; half of those deaths resulted from prescription opioids.

Treatment for opioid use disorder comes in many forms; this bill only deals with treatments that rely on medically- and clinically-provided services. These can include:

Residential or inpatient addiction treatment, or what is commonly known as “detox” or “rehab,” where patients remain in residential facilities for a given period of time in order to allow their bodies to detoxify from drug dependence, to spend time away from their previous environments, and to explore various behavioral support systems;

Counseling and behavioral therapy, which provides a variety of psychological tools to assist in recovery and reduce the risk of relapse; tools include skill building, adherence to a recovery plan, group therapy for social reinforcement, and professional/educational outcomes assessments. These services are often provided in residential treatment facilities in tandem with medication-assisted treatment; and

Medication-assisted treatment, which involves the provision of various drugs to combat withdrawal symptoms, to mitigate cravings, and to prevent relapse. Specific to opioid use disorder, there are several drugs involved in MAT:

Methadone is a slow-acting opioid agonist, which mimics the effects of opioids, thereby reducing withdrawals and cravings. It is only available once daily at methadone clinics;

Buprenorphine is a partial opioid agonist, which produces similar effects to opioids but in diminished effect. It is proven to be effective at combating withdrawal symptoms and cravings; and

Naltrexone is an opioid antagonist, which does not have the effects of opioid drugs. Naltrexone binds and blocks the opioid receptors, preventing the feeling of getting “high” when users take opioids on the medication. It is available in pill form or a monthly intramuscular injection.

There are many different goals and measures regarding the effectiveness of various treatments used in different fields. Public health officials often cite statistics regarding disease transmission or overdose deaths. Economists look to statistics on employability, or conduct cost-effectiveness comparisons of providing treatment versus either not providing treatment or using punitive approaches. The criminal justice field often measures crime rates or recidivism. Notably, the National Institute of Drug Abuse does not consider relapse a measure of treatment failure, even though it claims that treatment reduces drug use by 40 – 60%.

Expanding Opportunities for Recovery Act of 2017 (HR 992) was introduced on February 9, 2017. The bill establishes a framework for providing grants to expand access to clinically appropriate services for opioid abuse, dependence, and addiction;

Opioid Abuse Prevention and Treatment Act of 2017 (HR 993) was introduced on February 9, 2017. The act aims to reduce opioid misuse and abuse by awarding grants to states to review how pharmacies are distributing opioid drugs. The Act would also require a Federal review of naloxone and would create an interagency working group to advise the States;

Comprehensive Opioid Abuse Reduction Act of 2016 (HR 5046) was passed in the House on May 12, 2016. The act authorizes the Department of Justice (DOJ) to award grants to state, local, and tribal governments to provide opioid abuse services; and

Comprehensive Addiction and Recovery Act of 2016 (S 524) was enacted into law on July 22, 2016. The act authorizes the DOJ and Department of Health and Human Services to award grants, and creates new regulations on the FDA approval of opioid drugs.

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